Online on-the-spot searching increases use of evidence in sharing decision making during consultations
Coulter and Ellins demanded ‘widespread implementation of innovations
to improve decision making and promote greater patient involvement’.(1) We
developed ‘Online on-the-spot’ (OOS) as a quality improvement project. It
aims to efficiently answer doctors’ educational needs and the patients’
unmet needs, by searching for online evidence in a structured way in
consultation with the patient.
The concept has its origins in a formula
developed by Slawson and Shaughnessy U = (R x V x I)/W.(2) Where U is the
usefulness of the information, R the relevance, V the validity, I the
interaction and W is the work to access the information.
In OOS the
relevance (R) of the search has to meet the criteria of a POEM: the paper
addresses a question that doctors encounter, it measures outcomes that
doctors and their patients care about and it has the potential to change
the way doctors practise. The validity (V) of the online information is
high if we use websites with relevant evidence-based information. The
amount of work (W) and time to search is minimal and the information
available in full text can be immediately implemented at the point of
Instead of a full and broad search on evidence, we focused on
sources with already appraised evidence, such as clinical guidelines,
especially Prodigy and Dutch GP guidelines. The interaction with the
patient (I) is also high because it’s his problem that leads to the
question, he can follow the search, waits on an answer and he expects an
explicit translation of the relevant information into a language that he
We registered the OOS-hits during three months.(3) For
each eight patient–doctor contacts, we did one search online. We found an
answer in more than eight searches out of ten. In four cases this produced
new information and in one search out of four the GP changed his decision.
In nearly half of the searches the patient participated together with his
doctor, concerning the search. Once a doctor was familiar with the method,
the time spent on a search and interacting with the patient was less than
5 min in more than 50% of cases. OOS connects the patient, the doctor and
(1) Coulter A, Ellins J. Effectiveness of strategies for informing,
educating, and involving patients. Brit Med J 2007;335:24-27.
(2) Slawson DC, Shaughnessy AF. Teaching evidence-based medicine:
should we be teaching information management instead? Acad Med
(3) Van Duppen D, et al., Online on-the-spot searching increases use
of evidence during consultations in family practice, Patient Educ Couns
(2007), in Press.
Competing interests: No competing interests